We realize that sometimes it’s a little difficult to really understand and navigate through all of the legal rules and regulations of the dental healthcare world. That’s why Maddison Ave Dental is here to help you by providing you with this short and precise guide on insurance terminology.
A Basic Glossary
- Annual Maximum – The maximum amount your policy will pay per year for care at Maddison Ave Dental. It is often divided into costs per individual, or per family if you have a family care plan.
- Co-payment – A monetary amount the patient pays at the time of service before receiving care, and before the insurance pays for any portion of the care.
- Covered Services – A list of all the treatments, services, and procedures the insurance policy will cover under your contract.
- Deductible– A dollar amount that you must pay out of pocket each year before the insurance company will pay for any treatments or procedures
- Diagnostic/Preventive Services – A category of treatments or procedures that most insurance companies will cover before the deductible which may include services like preventive appointments, X-rays, and evaluations.
- In-Network and Out-of-Network – A list of providers that are part of an insurance company’s “network”.
- If you visit in-network providers, the insurance company will typically cover a larger portion of the cost of the care you receive. If you visit someone who is not part of the network, known as an out-of-network provider, the insurance company may pay for a portion of the car but you will pay a significantly larger share from your own pocket.
- Lifetime Maximum – The maximum amount that an insurance plan will pay toward care for an individual or family (if you have an applicable family plan)
- This is not a per-year maximum, but rather a maximum that can be paid over the entire life of the patient.
- Limitations/Exclusions – A list of all the procedures an insurance policy does not cover.
- Coverage may limit the timing or frequency of a specific treatment or procedure (only covering a certain number within a calendar year), or may exclude some treatments entirely. Knowing the limitations and exclusions of a policy is very important.
- Member/Insured/Covered Person/Beneficiary/Enrollee– Someone who is eligible to receive benefits under an insurance plan.
- Providers at Maddison Ave Dental – Dr. Kostika Polena, Dr. Andrew Schneider, Dr. Kathleen Uy, Dr. Matt Welebir, or other oral health specialists who provide treatments.
- Waiting Period – A specified amount of time that the patient must be enrolled with an insurance plan before it will pay for certain treatments; waiting periods may be waived if you were previously enrolled in another dental insurance plan with a different carrier.
Knowing Your Plan
There are many different insurance options available; we advise that you find out exactly what your insurance covers. It’s important to review your plan with a qualified insurance specialist. At Maddison Ave Dental, we proudly help each and every one of our patients get the care they need when they need it thanks to our insurance care team. Don’t be afraid to ask questions regarding your policy so you can be confident the next time you come in for a treatment at our North Las Vegas dental office.
Contact Us Today
For more information on Maddison Ave Dental for insurance coverage questions or to set an appointment today with one of North Las Vegas’ best dental practices, call (702) 735-9500 or visit our Financing and Insurance page.